Gamma Knife Radiosurgery For Vestibular Schwannomas: Long Term Results In 249 Patents.





Keywords: vestibular schwannoma, outcome, hearing function, radiosurgery, brain tumor

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Abstract

     Careful objective evaluation of clinical and imaging outcomes of Gamma Knife Radiosurgery (GKRS) in patients with non NF-2 vestibular schwannomas.
     The purpose of validating the continued use of GKRS as a primary modality in the definitive management of Vestibular schwannomas.
     Two hundred forty-nine (249) consecutive patients with vestibular schwannomas treated with GKRS, were followed clinically and with serial imaging.
      Image analysis for volumetric assessment of outcome was performed with a intramurally developed and validated software package to provide objectivity. Data was mined with a PostgreSQL database and analyzed with SPSS Version 15.0. Minimum follow up of 2 years and follow up extending up to 12 years is available on all patients. Dose ranged from 10 -13 Gy to the edge of the tumor. Treatments were performed with model B and 4C units.
     Tumor control was obtained in 240 (96%) patients with volume reduction in excess of 15% was observed in 182 (73%). Increase in volume in 9 patients prompted repeat radiosurgery in 3 patients. No further management was required in 6 patients. Clinical adverse effects were observed in 4 patients (2%) and consisted of dizziness (1), facial weakness (2), hemifacial spasm (1) and hydrocephalus (1) patient. Hearing was preserved in 78% percent of patients with useful hearing at time of GKRS at 5 years. Facial paresis appeared postoperatively in two patients and improved to Grade I House Brackmann on corticosteroid treatment.
     This was a retrospective study.
     GKRS is offered as primary management of vestibular schwanommas.
     At our institution, it is an alternative to microsurgery on the basis of these findings.


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